Emergency Department · Education & Operational Readiness

ED Sepsis Education & Operational Readiness Tool

The first 60 minutes: recognition, stratification, and the Hour-1 Bundle. Grounded in the Surviving Sepsis Campaign 2026 guidelines and CMS SEP-1 within the Hospital Value-Based Purchasing program (FY 2026 performance accountability).

Model design by Kelly Emrick, DHSc, PhD, MBA, BSRT(ARRT)R
Educational and operational tool. This model supports clinician and staff education, workflow design, and performance improvement. It does not replace clinician assessment, institutional policy, or real-time EHR-integrated decision support, and it is not for individual clinical decision-making. All values are illustrative; clinical judgment and institutional protocols govern patient care.

What changed: Surviving Sepsis Campaign 2026

The SSC international guidelines were updated in 2026 (published 23 March 2026), adding 46 new statements. This tool reflects that update. Key points that shape ED workflow:

  • Initial fluid (at least 30 mL/kg crystalloid in the first 3 hours for sepsis-induced hypoperfusion or septic shock) is now a conditional recommendation (low-certainty evidence), with explicit emphasis on individualizing volume and frequent reassessment.
  • Peripheral initiation of vasopressors is suggested to avoid delays from central access.
  • For adults 65 and older with septic shock, an initial MAP target of 60 to 65 mmHg is suggested rather than higher.
  • Serial lactate is suggested to guide resuscitation; active fluid removal is suggested after the initial resuscitation phase to limit overload.
  • For possible sepsis without shock, a brief period (up to 3 hours) of rapid evaluation is acceptable when diagnostic uncertainty exists; for septic shock, antimicrobials are recommended immediately, ideally within 1 hour.

The triage window matters

Roughly half of US hospitals fail the CMS SEP-1 bundle. With FY 2026 reimbursement now tied to 2024 performance through the Hospital Value-Based Purchasing program, the gap between recognition at triage and bundle initiation is no longer only a quality metric. It is a financial one.

~50%iNational SEP-1 compliance has been reported to hover around half of cases; CMS publicly reports SEP-1 results on Care Compare. Verify the current national figure against the latest CMS reporting period.
National hospital SEP-1 compliance (approximate)
CMS public reporting (Care Compare)
FY26iSEP-1 was added to the Hospital VBP program via the FY 2024 IPPS Final Rule (Aug 2023). Baseline period CY2022; performance period CY2024; payment impact begins FY 2026.
SEP-1 enters Hospital VBP payment
CMS FY 2024 IPPS Final Rule (CMS-1788-F)
350k+iCDC: sepsis contributes to at least 1.7 million adult hospitalizations and at least 350,000 adult deaths annually in the United States (MMWR / CDC Hospital Sepsis Program Core Elements).
US adult sepsis deaths per year
CDC, NHSN / Core Elements
1.7MiCDC: at least 1.7 million US adult sepsis hospitalizations annually. Globally, SSC 2026 cites approximately 49 million cases and 13 million sepsis-related deaths each year.
US adult sepsis hospitalizations per year
CDC (global: ~49M cases / SSC 2026)

Where this dashboard sits in the sepsis cluster

PageScopePrimary user
SEPSIS (overview)Educational overview: pathophysiology, definitions, evidence baseLearners, leaders, board reviewers
SEPSIS Screening ToolGeneral-purpose screening across inpatient settings (floor, ICU, ED)Bedside RN, RRT, hospitalist
ED Sepsis Readiness Toolthis pageED arrival to first 60 minutes: stratification, bundle initiation, SEP-1 captureED triage RN, ED provider, sepsis coordinator

How to use this tool

  • Triage Stratifier — enter vitals and mentation to view qSOFA, SIRS, NEWS2, and Sepsis-3 organ-dysfunction flags side by side, with cautious concordance language.
  • Hour-1 Bundle — start the clock at sepsis recognition (Time Zero). Log each element as it completes; the tool tracks elapsed time and completion percent.
  • Disposition — synthesizes inputs into floor, step-down, or ICU framing with rationale shown.
  • SEP-1 Builder — checklist of what must be documented and the time windows that determine pass or fail.
  • Program KPIs — calculators for time-to-antibiotic, bundle completion percent, and observed-to-expected mortality.

This page distinguishes clinical evidence (what improves outcomes) from CMS performance accountability (what is scored). The two are related but not identical, and the tool labels each accordingly.

Triage stratifier

Enter values available at triage. Scores recalculate live. Tools are shown side by side because no single score is sufficient on its own.

qSOFA
0
Below threshold
SIRS
0
Below threshold
NEWS2 (partial)
0
Low
Sepsis-3 organ flags
0
None flagged
Concordance

Enter values to see concordance guidance.

On screening choice: The Surviving Sepsis Campaign recommends against using qSOFA as a sole screening tool, citing low sensitivity. SIRS, NEWS, NEWS2, or MEWS are more sensitive screens. qSOFA remains useful as a marker of severity, not as a stand-alone rule-out. The NEWS2 value here is a triage-available approximation and is not a substitute for a fully scored NEWS2.

Hour-1 Bundle

Start the clock at the moment of sepsis recognition (Time Zero). Log each element as it is completed. The five conventional implementation components are shown below.

Elapsed since Time Zero
00:00
Not started

0 of 5 elements · 0%

✓

1 · Measure lactate

Initial lactate to assess tissue hypoperfusion. Remeasure if the initial value is elevated (serial lactate is suggested to guide resuscitation).

✓

2 · Obtain blood cultures before antimicrobials

Draw cultures before antibiotics when doing so does not materially delay treatment. For septic shock, do not let culture timing delay antimicrobials.

✓

3 · Administer broad-spectrum antimicrobials

For septic shock or high likelihood of sepsis, give immediately, ideally within 1 hour. For possible sepsis without shock and diagnostic uncertainty, a brief rapid-evaluation window (up to 3 hours) is acceptable.

✓

4 · Begin crystalloid for qualifying hypoperfusion / shock

At least 30 mL/kg IV crystalloid within the first 3 hours for sepsis-induced hypoperfusion or septic shock (SSC 2026: conditional recommendation, low-certainty evidence). Use actual body weight, or adjusted/ideal body weight if BMI > 30.

Clinical caution: Fluid volume is not one-size-fits-all. Institutional protocols should address patient-specific risks such as heart failure, renal impairment, and concern for fluid intolerance. SSC 2026 emphasizes frequent, ongoing reassessment to avoid harms of under- or over-resuscitation, and supports a liberal or restrictive strategy after the initial 30 mL/kg based on individual patient and health-system factors.
✓

5 · Vasopressors to maintain MAP ≥65 mmHg

If hypotension persists during or after fluid resuscitation, start vasopressors to maintain MAP ≥65 mmHg. Peripheral initiation is suggested to avoid delay; early concurrent use may be appropriate in unstable patients. For adults 65+, an initial MAP target of 60 to 65 mmHg is suggested.

Clinical evidence and the SEP-1 regulatory framework are related but not perfectly aligned. This tool tracks both so leaders can see where clinical best practice and abstraction criteria diverge.

Disposition framing

Combines the stratifier inputs with lactate and vasopressor status into a level-of-care framing. This is educational framing to support pathway design, not an individual placement order.

Note: disposition also reflects the NEWS2 and organ-flag values from the Triage Stratifier tab.

Suggested level of care
General floor (with sepsis surveillance)

    SEP-1 documentation builder

    SEP-1 is scored all-or-none: a single missing or mistimed element fails the entire bundle even when the clinical care was excellent. Use this checklist to confirm what must be documented and when. The most common failure points are fluid documentation, antibiotic timing, and the repeat lactate.

    0 documented

    Abstraction criteria follow the CMS SEP-1 specifications manual and can differ from current clinical guidance. Map your protocol to the abstraction criteria, not only to clinical logic, and confirm windows against the current specifications version.

    Program KPIs

    Quick calculators for the three measures most ED sepsis programs track. Charts below are illustrative.

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    —

    —

    Bundle element completion

    Illustrative element-level completion. Repeat lactate and crystalloid documentation are common weak points.

    Time to antibiotic trend

    Illustrative quarterly trend against a 60-minute target for septic shock.

    References & sourcing

    Figures cited above are linked here for auditability. Evidence is graded by source type; preprints are labeled and should not be treated as peer-reviewed.

    Guideline
    Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Intensive Care Medicine. 2026. doi:10.1007/s00134-026-08361-1. link.springer.com
    Guideline
    Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. SCCM / ESICM. (qSOFA: strong recommendation against use as a sole screening tool.) sccm.org
    Regulatory
    Centers for Medicare & Medicaid Services. FY 2024 IPPS/LTCH PPS Final Rule (CMS-1788-F), August 2023 — adds SEP-1 to the Hospital VBP program (baseline CY2022, performance CY2024, payment FY2026). Hospital VBP links inpatient payment incentives to quality performance. cms.gov
    Regulatory
    CMS. SEP-1: Early Management Bundle, Severe Sepsis and Septic Shock — Specifications Manual for National Hospital Inpatient Quality Measures. Confirm abstraction windows against the current specifications version. qualitynet.cms.gov
    Surveillance
    CDC. Hospital Sepsis Program Core Elements; and Sepsis Program Activities in Acute Care Hospitals — NHSN, United States, 2022. MMWR. (Sepsis contributes to at least 1.7 million adult hospitalizations and at least 350,000 adult deaths annually in the US.) cdc.gov
    Epidemiology
    Rhee C, Dantes R, Epstein L, et al. Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014. JAMA. 2017;318(13):1241-1249. doi:10.1001/jama.2017.13836. (Foundational US clinical-surveillance estimate; see also Rhee/Klompas surveillance work through 2024 for updated electronic-data methods.)jamanetwork.com
    Preprint — not peer-reviewed
    Mahoro (2025). Machine-learning sepsis triage prediction. Preprint. Cited for illustrative context on AI-assisted ED triage only; preprints have not completed peer review and should not be used as evidence of clinical validity. Verify the publication venue and peer-review status before relying on this source.
    Methods
    Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287. jamanetwork.com

    Scoring engines (qSOFA, SIRS, NEWS2, Sepsis-3 organ flags) are implemented from their published criteria. The NEWS2 readout here uses triage-available parameters and is an approximation, not a fully scored NEWS2.

    Built on the Population Health Bible (PHB) design system · v2.0.0 · Surviving Sepsis Campaign 2026 and CMS SEP-1 (FY 2026 HVBP).

    © Kelly Emrick, DHSc, PhD, MBA, BSRT(ARRT)R · kellyemrick.com

    Suggested citation: Emrick K. ED Sepsis Education & Operational Readiness Tool. kellyemrick.com; 2026.

    Kelly Emrick, DHSc, PhD, MBA